A New Kind of Drug Abuse

ADHD is rising in prevalence and many of those diagnosed with the disorder receive prescriptions for management of symptoms. One of the undesirable byproducts of this increasing treatment seems to be a new type of drug abuse.

Prescription stimulants used to control ADHD have been abused by patients and even by individuals who do not have the disorder. Given that patients with the intent to obtain unneeded ADHD prescriptions may approach psychiatrists, neurologists, primary care doctors, or emergency medicine physicians, it is important for all healthcare providers who prescribe these drugs to be aware of the potential for abuse of these substances and to learn to recognize signs of abuse.

Reasons for ADHD Medication Abuse

Dependence and tolerance

Many ADHD medication abusers are individuals who have been prescribed stimulants for valid reasons. Dependence on the medication and tolerance to the physiological effects can trigger ADHD medication abuse.

Desired stimulant effect

Because some of the medications used for ADHD have pharmacological stimulant activity, they hold the potential for abuse among youth and adults who crave the CNS stimulant effects to self-treat underlying, undiagnosed mood disorders.

Some individuals, particularly youth, may want to try stimulants out of curiosity. Patients who are given prescriptions for their medical condition might share pills with friends or family members who have not been professionally evaluated for ADHD. This type of casual “sharing” is the initial introduction to prescription ADHD medications for some individuals.

Self-diagnosis

Some individuals may self diagnose themselves with ADHD. Parents might diagnose one of their children with ADHD after another child in the family has been diagnosed and provided with a prescription. This attitude of self-identifying and self-treating (or of parents diagnosing and treating their children) can trigger unchecked use and abuse.

Parental encouragement

Competitiveness for good grades combined with a rudimentary exposure to the concept of prescription CNS stimulant medications can give some parents the false impression that providing their children with CNS stimulants might help them achieve better outcomes on examinations. The irony in this population is that parents may have the financial resources and the ability to manipulate medical professionals to obtain unnecessary prescriptions but have little to no education in how to accurately comprehend medical information.

Signs of toxicity

Toxicity includes sympathomimetic symptoms such as agitation, tremors, movement abnormalities, seizures, hypertension and tachycardia.

Recognition of abuse

Patients who abuse ADHD medications are more likely to pay cash for their inappropriately obtained medications and to shop around for doctors, often crossing state lines and traveling a great distance to obtain these legal but inappropriate substances.

Physician action points

Doctors must learn to recognize signs of ADHD medication abuse, including exaggeration of symptoms, insistence on obtaining prescriptions, unusual pharmacy locations, and erratic scheduling of office visits.

Discussion Points

► What experiences do you have with patients who abuse ADHD medications?

► What methods have you used to identify, discourage, or prevent this type of drug abuse?

Disclosures:

References:

Cepeda MS, et al. Doctor shopping for medications used in the treatment of attention deficit hyperactivity disorder: shoppers often pay in cash and cross state lines. Am J Drug Alcohol Abuse. 2015 May;41(3):226-229.

Clemow DB, et al. The potential for misuse and abuse of medications in ADHD: a review. Postgrad Med. 2014 Sep;126(5):64-81.

Fitzgerald KT, et al. Adderall® (amphetamine-dextroamphetamine) toxicity. Top Companion Anim Med. 2013 Feb;28(1):2-7.

Spiller HA, et al. Overdose of drugs for attention-deficit hyperactivity disorder: clinical presentation, mechanisms of toxicity, and management. CNS Drugs. 2013 Jul;27(7):531-543.